P01 ICU RN DRAFT PWS Housotn Tx.docx

?.## PERFORMANCE WORK STATEMENT (PWS)

ONSITE ICU NURSING SERVICES

1. SERVICES

1.1. This is a NON-PERSONAL services requirement for 30 registered nurse services to provide onsite Intensive Care Unit (ICU) or Urgent/Critical Care Nursing Services at the Michael E. DeBakey VA Medical Center (MEDVAMC) located at 2002 Holcombe Boulevard, Houston, TX 77030. Contractor’s personnel shall perform on-site nursing services for varying periods of time and in various areas of MEDVAMC and based on their qualifications, may be required to work in areas of the highest need on the date of their scheduled shifts. Contractor’s personnel shall be subject to the quality assurance standards established by the Joint Commission and shall perform in accordance with ethical, professional and technical standards of the healthcare industry consistent with VA policy, regulations, procedures and protocol.

1.2. The parties agree that contract personnel shall not be considered VA employees for any purpose and Contractor’s personnel will not perform any supervisory duties during the term of the contract. Only those services specified herein are authorized. Changes to the contract are not authorized unless in writing by the Contracting Officer.

1.3. The contractor shall provide a point of contact to which the Contracting Officer’s Representative (COR), Associate Director, Patient Care Services (ADPCS) or designee Clinical Administrative Supervisor (House Supervisor) can coordinate and report problems 7 days a week, 24 hours a day. During normal administrative hours, 8:00 AM to 4:30 PM Monday through Friday excluding holidays, the contractor shall coordinate and report any problems with the COR. The contractor shall report any problems that occur outside normal administrative hours to the House Supervisor.

1.4. Authority: Title 38 USC 8153 Contracting Authority combination with FAR Part 13.5.

2. POSITION DUTIES AND RESPONSIBILITIES:

2.1. RN: The RN will utilize their broad based clinical knowledge to effectively assess, implement health promotion and prevention interventions, manage acute and chronic illness states, assist patient/residents in the attainment of optimal levels of functioning rehabilitation, evaluate patient/resident response to actual or potential health problems, and provide supportive measures for the dying patient/resident and their significant others. Nursing care is performed in accordance with the Texas Registered Nurses Practice Act and within the individual nurse’s scope of license. The VA Nurse Manager(s), or appropriate nursing leadership delegate (i.e. Assistant Nurse Manager), will provide the RN with clinical oversight during their tour of duty. More specific duties and responsibilities of the Registered Nurse are described below and shall be assessed by MEDVAMC prior to provider acceptance.

2.1.1. Maintain patient/resident confidentiality and a safe patient/resident care environment, including familiarity with requirements such as medication administration, patient/resident/family education, discharge process, restraint usage, hazardous waste disposal, etc., as defined by The Joint Commission and all other VA regulatory bodies (i.e. Long Term Care Institute and Office of Inspector General).

2.1.2. Provide patient/resident-centered care by performing the following tasks:

2.1.2.1. assess the health care needs of the patient/resident and maintain or develop a plan of care to meet interdisciplinary goals

2.1.2.2. assess and act on significant changes in the patient’s/resident’s health condition

2.1.2.3. carry out the plan of care by performing/assigning delegated tasks

2.1.2.4. collect and document pertinent data into the electronic patient/resident medical record

2.1.2.5. complete nursing assessments within required time frames, and in accordance with policy and procedure

2.1.2.6. identify and act on predictable needs of the patient/resident

2.1.2.7. meet the health care needs of patient/resident by assessing and assisting the patient/resident to meet expressed needs

2.1.2.8. meet the emotional and spiritual needs of patients/residents and/or families

2.1.2.9. prioritize and complete tasks within the RN’s assigned shift

2.1.2.10. update patient/resident care plans

2.1.2.11. notify assigned physician of any changes in condition

2.1.2.12. report incidents of verbal or physical abuse immediately to the Nurse Manager of the unit they are assigned; or designated off-shift nursing leadership

2.1.3. Perform the following tasks:

2.1.3.1. head-to-toe assessment

2.1.3.2. insert IV lines

2.1.3.3. care and management of peripheral and central lines, including PICC lines

2.1.3.4. administer medication including IVs

2.1.3.5. coordinate and participate in admission and discharge of patient

2.1.3.6. measure vital signs/hemodynamic monitoring including Pain (the 5th Vital Sign), pulse oximetry, etc.

2.1.3.7. perform wound care including dressing changes (sterile and non-sterile), and obtaining wound cultures as necessary

2.1.3.8. obtain and deliver specimens to lab

2.1.3.9. perform tracheostomy care

2.1.3.10. perform non-acute and/or acute ventilator care, if needed

2.1.3.11. perform suctioning including oral, nasogastic, and tracheostomy

2.1.3.12. perform deep suctioning, which may include obtaining specimens

2.1.3.13. assess for and administer tube feedings

2.1.3.14. assist with routine urinary and bowel elimination including catheters, colostomies, and digital stimulation educate patients/residents and/or families regarding health and diagnoses and medication administration including indications for the medication.

2.1.3.15. respond and assist in an emergency situation

2.1.3.16. provide clinical oversight to Licensed Practical Nurses, Nursing Assistants and Health Technicians

2.1.4. Conflict of Interest: The Contractor and all contractor’s nurse (s) and other contract provider (s) are responsible for identifying and communicating to the Contracting Officer and COR conflicts of interest at the time of quotes and during the entirety of contract performance. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.

2.1.4.1. Under the performance of this contract, a Government employee who is employed by the Contractor is prohibited from participating personally and substantially on behalf of the Government through decision, approval, disapproval, recommendation, rendering of advice, certifying for payment or otherwise in that contract. No VA employee who is an employee, director or trustee of an affiliated university or who has a financial interest in the contract may lawfully participate in a VA contract or any other Government contract with the contractor.

2.1.4.2. In relation to the contract monitoring procedures a Government employee who is also employed by the contractor may not certify bills for payment. An employee who is not an employee, officer, director or trustee of the contractor and who does not have a financial interest in the contract shall perform this duty. The agency grants the VA the right to hire agency staff with a 30-day notice and at no additional fee. Contract personnel cannot work for the VA under the Fee Basis Program and through the Agency.

2.1.5. Citizenship related Requirements:

2.1.5.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals.

2.1.5.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E- Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.5.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.5.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.5.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFQ using the subject attachment in Section D of the solicitation document.

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the Contracting Officer is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non-Personal Healthcare Services: The parties agree that the Contractor and all contractor’s nurse (s) shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Inherent Government Functions: Contractor and Contractor’s Nurse (s) and other contract provider (s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.6. No Employee status: The Contractor shall be responsible for protecting Contractor’s Nurse (s) and other contract provider (s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.6.1. Workers’ compensation

2.6.2. Professional liability insurance

2.6.3. Health examinations

2.6.4. Income tax withholding, and

2.6.5. Social security payments.

2.7. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contractor’s nurse (s) and other contract provider (s). When a Contractor or contractor’s nurse (s) and/or other contract provider (s) have been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contractor’s nurse (s) or other contract provider (s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.7.1. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required.

2.8. Personnel Substitutions: Personnel Substitutions: During the first 30 calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the Contracting Officer, in writing, within 2 calendar day (s) after the occurrence of any of these events and provide the information required below. After 5 days, the Contractor shall submit the information required below to the Contracting Officer at least 2 calendar days prior to making any permanent substitutions.

2.8.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the Contracting Officer. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The Contracting Officer will notify the Contractor within 2 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.8.2. For temporary substitutions where the key person shall not be reporting to work for three

(3) consecutive workdays or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.8.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s nurse (s), s/he may request, without cause, immediate replacement of said Contractor’s nurse (s). The Contracting Officer and COR shall deal with issues raised concerning Contractor’s nurse (s) conduct. The final arbiter on questions of acceptability is the Contracting Officer.

2.8.4. Contingency Plan: Because continuity of care is an essential part of MEDVAMC’s medical services, the Contractor shall have a contingency plan in place to be utilized if the Contractor’s nurse (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. FOR ALL POSITIONS:

3.1. The contract nursing staff shall complete and document all assessments accurately and within assigned timeframes.

3.2. The contract staff assigned shall be physically able to carry out measures under the “Prevention and Management of Disruptive Behavior (PMDB),” which includes prevention techniques, basic self-defense, and the ability to perform a therapeutic containment to provide care in the Acute Medical/Mental Health units.

3.3. The contract nursing staff shall, at all times, conduct themselves in a professional manner treating patient/residents, visitors, and staff in a courteous manner. Sustained allegations of patient/resident or coworker abuse, both verbally or physically, will result in immediate removal from MEDVAMC, and will also be reported to the Contracting Officer. These incidents may result in that contractor employee not being eligible for continued contract performance with MEDVAMC.

3.4. Dress apparel: Contractor personnel shall be required to dress in a professional manner and in accordance with VA Handbook 1850.4 Employee Uniforms. VHA Handbook 1850.04.

4. CONTRACT RNs:

4.1. Bar Code Medication Administration (BCMA) with a 100% accuracy rate shall be used in the applicable areas for medication administration. BCMA is designed to provide electronic validation and documentation of medication administration, reduce medication misadventures, provide an online patient/resident medication record, and promote a safer inpatient/resident care environment. Spot check (use random review) of patient/resident charts or review of incident reports will be conducted. If issues are found, remedial training of contractor employee will be given. If remedial training is unsuccessful, the contractor employee may be removed from providing services under the Contract.

5. SCHEDULING:

5.1. The following entities/positions are authorized by the Contracting Officer to place requests with the contractor for services required under this contract: ADPCS or designee, Clinical Administrative Nurse (House Supervisor) or COR. The VA shall provide Contractor with the names, titles and telephone numbers of individuals authorized to request staffing. Contractor’s personnel will be scheduled for shifts (Day, Evening, Night, Weekend, etc.) based on the needs of MEDVAMC, providing maximum flexibility to the appropriate VA authority in scheduling.

5.2. MEDVAMC does not guarantee a set contract or number of hours for any agency personnel. Contractor shall maintain sufficient VA credentialed staff to meet service requests for uncovered shifts. Contractor shall confirm with VA the ability to meet all scheduled coverage requirements upon award of the contract.

5.3. The VA reserves the right to cancel or change any scheduled shift of any contract personnel with at least a two-hour notice to the contractor prior to cancellation of a shift, at no cost to the VA.

If the VA fails to provide two-hour advance notice, the contractor may charge the VA for two (2) hours from the beginning of the cancelled shift. The VA retains the right to change the scheduled shift and/or work location within MEDVAMC, provided the nurse is clinically qualified to work in the area.

5.4. Contract nursing staff must contact their agency regarding cancellations, changes in scheduling, etc. The contractor will, in turn, contact MEDVAMC of employee cancellation and advise the name of the replacement provider. The Contractor will provide notification of cancellations at least two (2) hours prior to the beginning of a scheduled shift. Contractor shall be responsible for any overtime costs to the government to provide coverage for any “no call/no show” shift. A short notice cancellation of less than four hours shall become the vendor’s responsibility to provide a replacement provider. Notification of, or the inability to provide, a replacement provider must be made to the MEDVAMC at least two (2) hours prior to the start of the scheduled shift.

6. TOUR OF DUTY: The contract resulting from this requirement shall provide maximum flexibility to the VA scheduling authority. MEDVAMC provides nursing services 24 hours a day, 7 days a week. Temporary contract nursing services shall supplement full time MEDVAMC staff on an as needed basis as staffing needs arise depending on vacancies, vacations, resignations, and illnesses to ensure required staffing levels are maintained. Notification of required needs may be between 24-48 hours. Coverage may include weekends, federal holidays, days, evenings, or overnights, and are variable within a 24 hour period. Contractor’s personnel shall be required to work any regular or irregular tour, with 8 hour and 12 hour tours typically being:

8 Hour Tour:

Day 0730-1600;

Evening 1530-2400;

Night 2330-0800; and

12 Hour Tour:

Day 0730-2000;

Night 1930-0800 (12 hour short shift – 8 hours – 0700-1530; 1500-2330; and 2300-0730).

Select units/areas may have tour starts that vary from these standard times.

6.1. Contractor’s personnel must be present at MEDVAMC during scheduled work hours and actually be performing required services identified herein or the Contractor’s payment will decrease accordingly. Contractor will be notified and required to have back-up plan to provide needed staff in the event of a no-show. A no-show is defined as the contract employee not being in place at the scheduled start time. Contractor will be notified within two (2) hours of the contract employee reporting for duty if their services are not needed due to a decrease in workload.

6.2. The scheduling, tracking and compensation of personnel in accordance with State or Federal Law is the sole responsibility of the Contractor. Overtime may be necessary and is applicable for anything hours over 48 hours weekly worked at MEDVAMC. Overtime must be pre-approved by the Staffing Office for the Contract and will not be allowed for contractor staff to complete charting in the medical record. All patient/resident documentation must be completed prior to leaving for the day. Day and evening eight hour (8) tours include a ½ hour non-paid lunch break as well as all twelve (12) hour shifts. If patient/resident care needs prevent the ability to take a 30 minute lunch, the Nurse Manager or Staffing Office must be notified during the said shift to provide coverage or authorize no lunch. Contractor will notify COR or House Supervisor if staffing needs can only be met through overtime. Hours worked by contractor’s employees at a facility other than those covered by this contract, shall not be included in the calculation for overtime compensation under this contract.

6.3. Contractor’s personnel must present a legible “service ticket” to the appropriate VA authority (Nurse Manager, Assistant Nurse Manager, Associate Nurse Executive or House Supervisor) for each shift worked, showing the individual’s name, date, work unit and hours worked to include meal breaks. The appropriate authority will initial and retain a copy for verification and payment purposes. Timecards signed by other than those listed above will not be accepted with invoices for payment.

7. BASIC QUALIFICATION/KNOWLEDGE SKILLS: Contractor shall ensure that all contract personnel have met the qualifying criteria outlined in this section. Personnel assigned by the contractor to perform the services covered by this contract shall have a current unrestricted license from a State, Territory or Commonwealth of the United States or the District of Columbia. The qualifications of such personnel shall also be subject to review/approval by the VA Nurse Executive or designee. Personnel shall be proficient in spoken and written English. Personnel shall be graduates of a professional, accredited nursing school approved by the appropriate State at the time the program was completed, or in the case of graduates from foreign schools of professional nursing, possession of current, unrestricted license as described herein will also meet the basic education requirement.

7.1. Individuals will be required to provide and maintain current license, applicable certifications, proof of a negative TB test within the past 12 months, pre-employment drug screening, and BLS certification and ACLS Certification. Contractor will provide proof of updated licenses and certifications to the COR or designated individual prior to being scheduled for MEDVAMC required training. Contractor will also provide proof of updated licenses and certifications to the COR or designated individual as they expire. Contractor will be responsible for completing initial competency evaluations based on VA-provided competency list and will provide completed assessment to COR. Individuals must meet physical requirements to perform a full range of duties without physical restrictions. Personnel must also have a working knowledge and basic skills in the use of personal computers (PC). Contract personnel are required to be credentialed through VetPro.

7.2. Evidence of completion of required licensure, credentials, required training, current competencies and initiation of background investigations must be validated for all contractor personnel referred to perform services under this contract prior to providing direct patient care.

7.3. Ultimately, the decision to accept or reject contract staff rests with the VA. Contractor shall not have any personnel report to duty until written notification is received from the Contracting Officer advising that the candidate(s) presented has met all requirements for contract performance.

8. SPECIFIC QUALIFICATIONS/KNOWLEDGE/SKILLS: This contract requires the services of RNs in various areas of MEDVAMC. In addition to the basic qualifications mentioned above, each area requires specific knowledge/qualifications, which are identified below. The experience required should be within the past five (5) years:

8.1. RN (Specialty Care – ICU/PACU/Cath Lab/Bronch, Emergency Department)

8.1.1. Current ACLS Certification 8.1.2.Current BLS Certification

8.1.3. One (1) year experience in Critical Care Nursing

8.1.4. Note: Contract nurse(s) performing services on this contract may not provide nursing services or pickup additional shifts at other health care systems/medical centers located within the Houston, Texas area concurrently will be providing services at MEDVAMC unless getting approval/authorization by designed VA personnel to do so.

9. MEDVAMC CONDUCTED TRAINING REQUIREMENTS: The Government requires that personnel attend the following training classes provided by MEDVAMC prior to reporting to the nurse on duty.

9.1. Nursing Service Basic Orientation (est. 4 hrs.)*

9.2. In-service/validation of competency for specific work area (est. 4 hrs.)

9.3. EHR (Electronic Health Record) System (est. 4 hrs.)

9.4. BCMA (Bar Code Medication Administration) (est. 4 hrs.)

9.5. All mandatory VA Training Topics

9.6. In-service/validation of competency for specific work area (est. 4 hrs.)

9.7. Electronic Health Record (HER) System) (est. 4 hrs.)

9.8. BCMA (Bar Code Medication Administration) (est. 4 hrs.)

9.9. All mandatory VA Training Topics

10. *MEDVAMC WILL REIMBURSE THE CONTRACTOR FOR THE NURSING SERVICE BASIC ORIENTATION CLASSES ONLY AT THE RATES SPECIFIED IN THE PURSUANT CONTRACT PAYMENT WILL BE MADE ONLY AFTER PERSONNEL HAVE COMPLETED A MINIMUM OF TWO (2) SHIFTS OF SERVICE AT MEDVAMC. IF THE CONTRACT EMPLOYEE FAILS TO ATTEND A SCHEDULED TRAINING CLASS WITHOUT PRIOR WRITTEN APPROVAL FROM THE COR OR HOUSE SUPERVISOR THIS WILL REFLECT ON CONTRACTORS PAST PERFORMANCE. FAILURE TO ATTEND A CLASS DUE TO ILLNESS WILL BE EXCUSED ONLY IF CONTRACTOR PROVIDES TELEPHONIC NOTICE TO COR OR HOUSE SUPERVISOR 2 HOURS PRIOR TO CLASS SCHEDULED START TIME. THIS CONTRACT SHALL PROVIDE MAXIMUM FLEXIBILITY TO THE VA AUTHORITY IN SCHEDULING.

10.1. All personnel performing services must complete orientation prior to beginning work on contract shifts:

10.2. 8 hours of computer-based pre-orientation work (off-site by contract nursing staff)

10.3. 3 day new employee orientation (on-site at MEDVAMC)

10.4. 1 day competency Assessment (on-site at MEDVAMC) **Competency Assessment will be pass/fail. Contract Staff must pass the assessment in order to begin working on the units

10.5. In addition, licensed RNs will undergo orientation consisting of one, eight hour shift in each unit area the professional intends to work; up to 32 hours (Acute Medicine, Acute Psychiatry, CLC, Ambulatory Care).

10.6. Former MEDVAMC employees who have separated from the facility within the previous 6 months will not be required to complete the orientation process prior to being eligible for scheduled shifts.

11. CONTRACTOR RESPONSIBILITIES: The contractor shall designate a Point of Contact (POC) who shall be responsible for overall performance of the work under this contract and shall have full authority to act for the Contractor on all matters relating to daily operation. The POC’s name and contact information shall be provided to both the Contracting Officer and the COR. The POC or designated alternate shall respond to calls from the COR or House Supervisor within thirty (30)minutes on a twenty-four (24) hour a day, seven (7) days a week basis for calls concerning personnel staffing problems or other issues requiring immediate attention.

11.1. Contractor shall provide scheduled services throughout the contract period. In the event of the absence of Contractor’s personnel for any reason, the Contractor shall bear the responsibility of providing replacement personnel to fulfill the requirement. During normal administrative hours, 8:00 AM to 4:30 PM Monday through Friday excluding holidays, the contractor shall coordinate and report any problems with the COR. The Contractor shall report any problems that occur outside normal administrative hours to the House Supervisor. The Contractor shall, in writing, keep the Contracting Officer informed of any unusual circumstances in conjunction with the contract.

11.2. The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract. To carry out this responsibility, the Contractor shall provide the following to their employees: Worker’s Compensation, Professional Liability Insurance, Health Examinations, Income Tax Withholdings, Social Security Payments and Pre- employment Drug Testing. Payments for any leave (sick, holiday, vacation, etc.) are considered the sole responsibility of the Contractor. The Contractor shall comply with all existing local, state and federal laws and regulations relevant to fringe benefits and premium pay for their employees. Contractor’s personnel shall not be considered VA employees for any purpose.

11.3. The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract. To carry out this responsibility, the Contractor shall provide the following to their employees: Worker’s Compensation, Professional Liability Insurance, Health Examinations, Income Tax Withholdings, Social Security Payments and Pre- employment Drug Testing. Payments for any leave (sick, holiday, vacation, etc.) are considered the sole responsibility of the Contractor. The Contractor shall comply with all existing local, state and federal laws and regulations relevant to fringe benefits and premium pay for their employees. Contractor’s personnel shall not be considered VA employees for any purpose.

11.4. The Contractor shall be responsible for providing the following to MEDVAMC: immediate notification of any pending or previous actions filed against an individual with the State Board, inquiry to the National Practitioner Data Bank, and the VA required Background Investigations (See #17). The contractor is responsible for providing to MEDVAMC the information for agency nurse 6-part folders that will include an Annual Appraisal form from the Contractor, licensure verification, proof of negative Tuberculosis (TB) and pre-employment drug screen within the past 12 months, current Basic Life Support (BLS), current Advanced Cardiovascular Life Support (ACLS) if appropriate, initial competency/skills checklist assessment, and training/education information.

11.5. The Contractor shall ensure the agency nurse completes the following online education courses, “TMS Privacy and HIPPA Focused Training” and “VA Privacy and Information Security Awareness and Rules of Behavior”.

11.6. The Contractor shall ensure the agency nurse completes the following online documents, eQUIP, Credentialing & Privileging worksheet, and VETPro.

11.7. All contractor employees shall be held to the same performance and conduct standards as MEDVAMC employees. Contractor nurses shall demonstrate proficiency in all elements of nursing process, assessment, planning, implementation and evaluation for the appropriate Criteria Based Functional Statement.

12. TERM OF THE CONTRACT: The performance period will be for 12 weeks from the award of the contract with the option to extend up to six months.

13. FEDERAL HOLIDAYS: The ten (10) holidays observed by the Federal Government are:

· New Year’s Day,

· Martin Luther King Jr.’s Birthday,

· President’s Day,

· Memorial Day,

· Independence Day,

· Labor Day,

· Columbus Day,

· Veterans Day,

· Thanksgiving Day,

· Christmas Day, and any other day designated by the President as a National Holiday. An administrative closure of Federal offices by Executive Order is not a Federal holiday for the purpose of holiday pay. Contractor will receive holiday pay for work performed only on the official holiday as designated by the Office of Personnel Management (OPM).

14. LIABILITY INSURANCE REQUIREMENTS: The Contractor will be required to carry the following types and amount of insurance through the contract period:

15. BADGES AND PARKING: All contractor personnel must by sponsored by an official VA Personal Identity Verification (PIV) sponsor (HR Representative, COR, or Program Director) to be issued a VA PIV credential for access to the VA network. All contractor personnel are required to wear their PIV card during the entire time they are on the VA grounds.

15.1. Contractor personnel are responsible for parking in appropriately designated parking areas and must use their PIV card for access into the parking lot/garage. Parking information is available from the MEDVAMC Police. MEDVAMC will not invalidate or make reimbursement for parking violations issued to Contractor’s personnel under any circumstances.

16. PAYMENT: Payment will be made for actual hours worked and at the rates shown in “Schedule of Services”. A Contract employee must be present at the VA facility and must be performing the services required of an RN to be eligible for payment. A record keeping system of Contract hours worked shall be established which shall include at a minimum sign-in/out sheets. Failure to sign-in, sign-out and provide signed service tickets shall result in nonpayment for those hours claimed. The Contractor will not be paid for any overtime not approved in advance by the Contracting Officer. Contract personnel must present a “service ticket” to the appropriate VA authority (Nurse Manager, Assistant Nurse Manager, Associate Nurse Executive or House Supervisor) for each tour of duty showing the individual name, date, work unit and hours worked including meal breaks. The appropriate supervisor will sign and retain a copy for verification and payment purposes. Invoices must be itemized to include the following information:

16.1. Time period being invoiced

16.2. Description of services

16.3. Unit cost billed

16.4. Extended amount due

16.5. Invoice number, date and

16.6. Order and obligation numbers.

16.7. Payment shall be made after the COR certifies that services identified within the billing period have been performed.

17. PROCEDURES FOR OIM/COMPUTER ACCESS: Access requirements to VA information systems by Contract personnel shall meet or exceed those requirements established for personnel as described in VHA Directives. A written and signed request for user access by VHA Management, or designee(s), constitutes management approval (sponsorship) to initiate a request for access to any sensitive automated information system. Access shall be granted to non-VA users only if the purpose for access meets criteria of the Privacy Act and VA Confidentiality regulations and transfer. To obtain access, the contractor must submit a written request with an original signature to VA Nursing Service Office fourteen (14) days prior to the orientation assignment. MEDVAMC will provide the VA form, ADP Security Notice & Request for Access. Contract personnel must complete VetPro process, be fingerprinted, and Background Investigation forms submitted as part of the Background Investigation requirement.

17.1. Contract personnel will be required to sign-on before starting work under this contract and abide by the VA Computer Access Security Agreement and Confidentiality Agreement. In the performance of official duties, the Contract personnel has regular access to printed and electronic files containing sensitive information, which must be protected under the provisions of the Privacy Act of 1974, HIPAA, and other applicable laws and regulations. The employee is responsible for (1) protecting that information from unauthorized release or from loss, alteration or unauthorized deletion, and (2) following applicable regulations and instructions regarding access to computerized files, release of access codes, etc. and (3) completing mandatory education regarding privacy and security as required by VA. Talent Management System (TMS) courses “Privacy and HIPPA Focused Training” and “VA Privacy and Information Security Awareness and Rules of Behavior” are required prior to agency nurse orientation. Courses will be accessed via the internet. Certificates of completion shall be sent to the COR.

17.2. Inappropriate usage of VA computer systems (as defined in the user access agreement) will constitute grounds for (at the least) terminating access for that person and (at the most) termination of the entire contract.

17.3. Inactive accounts for 90 days are automatically flagged by VistA and require action by OIT to remove the flag before the user can log back into the system. Accounts that are inactive for 6 months are “terminated.” If this occurs, one must go through the process of requesting access as described above before access will be reinstated.

18. CONFIDENTIALITY/PRIVACY ACT: The Contractor understands and agrees that the information in the medical records of all patients is confidential. Strict confidentiality is to be maintained, Rules of Confidentiality expected to be conformed with are delineated in 38 U.S.C. 3301, 38 U.S.C. 4132, 5 U.S.C. 552(a) et.seq. The Contractor and its personnel shall be held liable in the event of breach of confidentiality. The Contractor is required to sign the attached BAA (Business Associates Agreement). Any person, who knowingly or willingly discloses confidential information from the authorizing VA Medical Centers, may be subject to fines.

19. MEDICAL RECORDS:

19.1. Authorities: Contractor’s nurse (s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

19.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

19.3. Disclosure: Contractor’s nurse (s) may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

19.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC.

19.5. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address:

Mary L. Reid, Privacy Officer/Freedom of Information Act Officer MEDVAMC 2002 Holcombe Boulevard Houston, Texas 77030 Telephone: 713-794-7948 Email: mary.reid4@va.gov

20. PATIENT SAFETY:

20.1. Patient safety incidents must be reported within 24 hours using Patient Safety Report. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit to the COR the Patient Safety Report, following up with COR as required or requested.

20.2. Adverse events will be reported to the VA Quality & Patient Safety Office to the Patient Safety Manager or Patient Safety Coordinator and entered into the Patient Safety Reporting System, as outlined in the National Center for Patient Safety Handbook (http://www.va.gov/ncps/Pubs/NCPShb.doc). Adverse events will be scored utilizing the Safety Assessment Code for determination of the need for conducting a Root Cause Analysis (RCA). Report adverse events to Patient Safety Program at 713-791-1414 ext. 26084

20.3. The Contractors shall report all incidents involving radioactive material to the NHPP and NRC in accordance with National Radiation Safety Committee SOP #5: “National Health Physics Program (NHPP) Incident Response Procedure” and NRC Reporting Requirements (10 CFR 20, 21, 30, 35).

http://nhpp.med.va.gov/NHPP_Procedures.asp

21. CONTRACT MONITORING PROCEDURES: The Contracting Officer will appoint a COR to assist with monitoring compliance with technical requirements of the contract. The Contractor will be provided with a copy of the COR’s authority and limitation of authority.

21.1. The COR will be responsible for handling service-related documentation such as time and attendance logs, sign in/sign out sheets and service tickets that verify services called for under the contract have been received by MEDVAMC. The COR shall ensure that proper invoices are certified for payment in a timely fashion.

21.2. COR will notify the Contracting Officer of any contract non-compliance immediately upon gaining knowledge of any such incident. The COR will use the Contract Discrepancy Report (CDR) form to document any problems that may arise during the term of the contract. The CDR along with any other backup documentation will be forwarded to the Contracting Officer. The Contracting Officer will then notify the contractor. Further, the COR will maintain copies of all the above-mentioned documents.

21.3. The COR cannot make changes to the contract, direct Contractor’s work, or obligate the Government in any way.

22. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT (QI) The Government may evaluate the quality of professional and administrative services provided in accordance with the standards (ACR standards and others) as outlined in this document, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment), in accordance with Federal Acquisition Regulation (FAR) 37.401(b). The following measures represent the performance standards required to be met and will be included on the government’s Quality Assurance Surveillance Plan:

22.1. Measure: House of Operations and Uniforms.

Performance Requirement: The Contractor shall provide contract nurse(s) during the stated contract hours. Neat and clean scrubs are to be worn. No artificial nails, visible body piercing, no false eye lashes, report to duty on time.

Standard: All (100%) contract nurse(s), will be on time and available to perform dressed in scrubs.

Acceptable Quality Level: 95%.

Surveillance Method: Observation of contractor providing contract nurse (s) during the stated contract hours.

Frequency: Daily.

22.2. Measure: Quality Care.

Performance Requirement: Tour of Duty Performance. Documentation, Shift report, Orders signed off completed by end of tour daily.

Standard: Evaluations completed weekly. Acceptable Quality Level: 95%.

Surveillance Method: Direct observation. Frequency: Weekly.

22.3. Measure: Patient Safety.

Performance Requirement: 1. Patient safety incidents must be reported to the authorizing VA Medical Center and the COR with 24 hours. No patient causative events. 2. Patient safety incidents must be investigated, confirmed and resolved.

Standard: 1. All 100% of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. 2. All 100% of patient safety incidents will be investigated, confirmed, and resolved. Findings will be reported to the contractor upon completion.

Acceptable Quality Level: 98%. Surveillance Method: Periodic Inspection. Frequency: Periodically.

22.4. Measure: Patient Satisfaction.

Performance Requirement: Patient complaints about the quality of service will be reported to the COR, and the Contractor. No more than one veteran or family complaint per quarter for nurse.

Standard: The COR shall notify the Contractor in writing of any complaints made by the patients.

Acceptable Quality Level: 98%.

Surveillance Method: Customer Feedback Random Sampling. Frequency: Random Sampling.

22.5. Measure: Mandatory Training.

Performance Requirement: Contractor shall complete all required trainings, per MEDVAMC policy. Maintain current CPR & AELS (required).

Standard: All 100% of required trainings are completed on time by contract nurse(s). Acceptable Quality Level: 100% Surveillance Method: Direct Observation, review of TMS. Frequency: At the discretion of COR. Random sampling.

22.6. Measure: License and Board Certification.

Performance Requirement: Contractor’s license must be current, full and unrestricted. All staff must have current BLS. All nurse (s) who work ICU must have ACLS.

Standard: All (100%) license must be current, full and unrestricted. Acceptable Quality Level: 100% Surveillance Method: Annually once a year. Frequency: Once a year.

22.7. Measure: Testing Required.

Performance Requirement: TB Test, HepB Test Background Checks: RNS: VetPro NAC: LOW SECURITY BACKGROUND CHECK.

Standard: TB Test required annually. HepB required annually or declination form. Background checks done prior to employment.

Acceptable Quality Level: 100%. Surveillance: reviewed once a year annually. Frequency: Once a year.

22.8. Measure: Privacy, Confidentiality and HIPPA.

Performance Requirement: Contractor is aware of all laws, regulations, policies, and procedures relating to Privacy, Confidentiality, and HIPPa and complies with all standards. Standard: All (100%) Contract nurse(s) comply with all laws, regulations, policies, and procedures relating to Privacy, Confidentiality, and HIPPA.

Acceptable Quality Level: 100% Surveillance Method: Review of TMS by direct observation. Frequency: At the discretion of COR. Random sampling.

23. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after…